Walk-in Clinic ,Travel Clinic & Pharmacy in Kitchener
Dr. Munira Farooqi
(MBBS, FRCOG, FRCSC)
Dr Abdul Farooqi
Please fill out this questionnaire and email it to email@example.com or fax to 519-893-6061
Due to the high volume of patient request, please allow some time for your form to be processed.
Health History Questionnaire (docx)
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